His ARM address warned of a profession 'on the edge', trying to deal with the 'double whammy' of NHS structural reforms and the 'sheer, unparalleled scale of demand'.

The consultant anaesthetist, who took over the top BMA job from GP Dr Hamish Meldrum last year, cited the roll-out of NHS 111 and the imposition of the 2013/14 GP contract deal as evidence of a government not prepared to listen to the profession.

GP contract negotiations this year should be the 'result of genuine partnership with the government' to improve patient care and not a 'hit and run on general practice', he said.

This echoes the tough line taken by doctors at the ARM, who left the BMA leadership in no doubt that they expect it to tackle the government head-on.

They voted for the BMA to consider balloting GPs on pulling out of work with CCGs and passed a no confidence vote in health secretary Jeremy Hunt - both steps this year's LMCs conference in May was not prepared to countenance.

Doctors also demanded the repeal of the Health and Social Care Act, and a BMA campaign to achieve this.

Commissioning

Three months into the health reforms in England, Dr Porter is adamant doctors do not feel empowered by clinical commissioning. 'The changes were sold by government as empowering doctors; we have found that has not happened,' he says.

'It is important to recognise the strength of feeling. Doctors are feeling angry because they are feeling disempowered.'

Dr Porter did not seek to dissuade the conference from expressing its doubts about the health secretary, telling delegates to 'feel free' to vote how they wished. He admits such votes are a double-edged sword and says he does not like personal attacks. But he hit out at Mr Hunt's claim that Labour's 2004 GP contract deal was to blame for rising pressure on A&E.

Party politics

The claim was Mr Hunt's attempt to turn the A&E problems into a party political issue, Dr Porter says.

'Where were these problems between 2004 and 2011?' he asks. The argument was merely 'knock-about for the dispatch box', he says.

Dr Porter welcomes the more conciliatory stance taken by Mr Hunt in recent weeks. He is 'very glad' the health secretary has acknowledged the problems in A&E are not solely a result of the 2004 GP contract.

The next step for the BMA in the out-of-hours row will be to respond to the urgent care review being carried out by Sir Bruce Keogh, NHS England's medical director.

Dr Porter says the problems are 'multifaceted' and GPs should not go back to handing out their telephone number to patients. 'We should not accept the terms of the government's debate,' he warns.

BMA

A year into this three-year term, Dr Porter claims he does not dictate the path of the BMA. 'Our direction is decided by the representative body,' he says. His task now will be turning ARM policy into action, which has proved tricky in the past year.

Last autumn the BMA was forced to climb down over plans for a patient pledge card, to limit private sector involvement in the NHS. Lawyers warned it could leave GPs facing legal action.

A less controversial alternative - a public awareness campaign on the BMA website about health reforms in England - was launched last month.

But does BMA policy matter to frontline GPs and can it influence the government? 'The BMA absolutely remains relevant,' Dr Porter argues, citing a rise in membership as proof.

The government has made it clear this year's GP contract negotiations will focus on GP access and out-of-hours services.

More than ever, GPs will hope the BMA has enough relevance and influence over government to secure a negotiated contract that the profession can deliver.